Stained glass art order form

Name:
E-mail Address:

Which item(s) would you like:
 

#1001	#1002	#1003	#1004	#1005	#1006
Dolphin $50	Margaritaville $100	Owl $300	Fireplace screen green $400	Fireplace screen blue $400	Flower w/Butterfly $75

Of any items above please note anything you would like to alter
such as choosing a different color:

Or would you like me to create something new?
Describe what you would like here:

If there is a problem submitting the form, e-mail your order/request to GlassedFromPast@aol.com